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Readiness Plan Guidelines for Health Sciences Learners' Clinical Training

Following President Gabel’s directive, health sciences learners have been removed from the clinical environment since March 16 and have transitioned their learning to the virtual environment including virtual clinical experiences. Health sciences education needs to adapt to the new reality of the Covid-19 era as learners need direct patient contact to develop critical workforce entry skills, and to meet graduation requirements.

  

| Guiding principles:

In the absence of a SARS-CoV-2 vaccine, returning learners into clinical settings safely requires a reintegration plan that adheres to the following guiding principles.

Guiding Principles

  • Public health and accreditation alignment
    Actions follow guidance from the Governor and the Minnesota Department of Health, the University of Minnesota President’s Office, and Campus Public Health Officer/VP of Academic Clinical Affairs, as well as accrediting bodies of national health sciences schools.

  • Safe work environment
    Minimizing risk for health care workforce related transmission of infection and including adequate personal protective equipment for health care providers, patients and learners.

  • Meaningful educational capacity for learners
    To verify and support the capacity of health systems including the availability of supervisors/preceptors and sufficient and relevant clinical volumes. 

  • Ensure learner preparation
    To ensure everyone graduates on time with required credits, experience, and competencies.

  • Advocate for learners
    To partner with learners and co-produce education that meets learner needs and does not disadvantage learners’ progress and preparation compared to their national peers.

  

| Procedures

Procedures

  1. Office of Academic Clinical Affairs communication to learners about the University’s Disability Resource Center (DRC), the mechanism by which learners confidentially communicate concerns about their ability to participate in an assigned clinical experience. The DRC page will be included in that communication. This communication serves as a reminder to learners that the DRC Texists as the primary mechanism by which to communicate their personal health/medical needs. The DRC is the legal entity able and equipped to hold medical information about a learner, and has existing processes in place that will apply regardless of whether a learner's concern is specific to SARS-CoV-2 exposure or other health concerns that a placement may pose for the learner. 

  1. Determination of clinical setting risk level (refer to Table 1). The school/program should determine the clinical setting risk level(s) to inform subsequent decisions of learner placement and requisite preparation prior to that placement. 

  1. Communication with learners about self-screening and attestation processes (refer to Table 2). The school/program is responsible for communicating self-screening and attestation processes to learners. Examples of self-screening considerations and instructions are outlined below.

  1. Communication with learners about required training prior to returning to clinical settings. The school/program is responsible for communicating these requirements to learners, and the mechanisms by which the requirements are met (online, demonstration; refer to Table 3). Required training might include the following topics, tailored to specific health science programs:

  • Theory of infection control and prevention

  • Handwashing 

  • Donning and doffing personal protective equipment 

  • Cleaning / conserving personal protective equipment, when applicable

  • N95 mask fit testing

  1. Tracking and documentation of required training compliance. All requirements will be tracked by school/program in accordance with current processes. 

  1. Adherence to current University and Campus Public Health Officer Requirements. The above procedures assume adherence to current University guidelines and CPHO exemption processes for learners returning to campus for training or to clinical settings.

Clinical Setting Risk Levels (table 1)

These risk levels are intended to provide schools/programs examples of considerations depending on the type, scope, and length of interactions with other individuals. 

Table 1. Clinical setting risk levels with implications for learners and their contacts


Clinical Setting Risk Levels & Examples
Learner Placement Considerations Others’ Considerations

Lowest Risk Settings- no in-person contact

  • Tele/video-health
  • Anything virtual

Self-screening, and training at discretion of school/program. 



Recommended:

  • Telehealth
  • Communication
  • Self-care / emotional health
No risk to patients or others.

More Risk Settings- limited in-person contact (with appropriate protections), and social distancing is possible


Examples:

  • Non-respiratory specialty clinics 
  • Retail, hospital-based pharmacy
  • Home visits
  • Community-based organizations (food shelves, youth drop-in centers)
  • Schools
  • Minnesota Department of Health, local public health departments
  • Veterinary facilities

Self-screening and training required (see Tables 2, 3).


Moderate risk to learners, mitigated by appropriate use of PPE, adherence to specific setting standards, and compliance with all training requirements.


PPE use/conservation will be specified by clinical partners and current guidelines (CDC, OSHA, MDH).

Moderate risk to individuals encountered in-person in these settings, mitigated by appropriate learner (and individual) use of PPE/masks and social distancing requirements.

Highest Risk Settings- extensive in-person contact requiring near-constant use of PPE and/or high-risk procedures and/or high-risk settings/populations served



Examples:

  • Hospitals
  • COVID+ unit/floor
  • Respiratory specialities/procedures
  • Dental services
  • Congregate living (nursing homes, group homes, jails, shelters)

Self-screening and training required (see Tables 2, 3).


High risk to learners, mitigated by appropriate use of PPE, adherence to setting standards, and compliance with all training requirements.

 

Note: Congregate living situations pose greater risk for poor outcomes if residents are infected (age, complex health conditions, proximity).

 

 

Screening Considerations (table 2)

Learners will need to self-screen and attest that they are symptom free and have been symptom free per the CDC parameters prior to entering clinical settings. Learners should expect clinical settings to also have specific re-entry requirements including attestation.

Table 2. Screening and implications

Individual Risk Status
SCREENING IMPLICATIONS
• Static risk to self (immunocompromised status, chemotherapy, other high risk disease conditions) Per OGC, learners choose to notify the Disability Resource Center of any concerns. Subsequent accommodations are worked out by DRC with the specific program. This risk can not be assessed independent of DRC.
• Dynamic risk to self (recent or current influenza like illness) If this dynamic risk exists, the learner can only be in low risk clinical settings until symptoms resolve per guidelines.

• Dynamic risk to others (SARS-CoV-2 symptom status - use up to date CDC list of symptoms)

Symptoms must resolve completely.


Then, isolation prior to any medium or high risk clinical placement per up to date guidelines.

• Dynamic risk to others (travel history, recent illness, known SARS-CoV-2 exposure)

Quarantine/isolation prior to medium or high risk clinical placement per most stringent applicable guidelines.
SARS-CoV-2 Status

SCREENING

IMPLICATIONS
  • PCR / active infection or antigen


Negative results do not eliminate the need for quarantine prior to entering aclinical site (for some clinical sites) because they might be infected/not yet shedding

Not required at this time.


Only those for whom the clinical setting requires this.

 

  • Serology / antibody testing


Not of great interest to clinical sites until we know more about result implications.

Not required at this time.



Only those for whom the clinical setting requires this.

Example Self-Screening Tools

Reference CDC 

At this web-site anyone can launch the “coronavirus self-checker”.

Learners must self-assess on the following:

  • Current symptoms (see below for current CDC symptom list)
    • If self-assessment indicates any symptom(s), get tested (Boynton is testing learners)
      • Negative COVID-19 - symptoms need to resolve prior to returning to clinical setting
      • Positive COVID-19 - follow CDC / MDH quarantine/isolation guidelines
  • Recent exposure to laboratory confirmed COVID-19 individual (community spread; this does not apply to exposure in clinical setting following proper PPE use)
    • Yes- follow isolation guidelines prior to returning to clinical setting
  • Recent activities / volunteering / work shifts in high-risk settings (e.g., congregate living situations)
    • Yes- need details and then decisions according to risk/situation
  • Recent travel (returning from outside of US per CDC guidelines as of May 2020)
    • Yes- follow isolation guidelines prior to returning to clinical setting

Learners must self-assess and attest prior to entry into a clinical setting that they do not have:

  • Cough
  • Shortness of breath or difficulty breathing
  • Fever (defined as feeling feverish or a measured temperature of 100.4o F [38o C] or higher)
  • Chills
  • Muscle pain
  • Sore throat
  • New loss of taste or smell

Example Learner Instructions

  • Use of PPE will follow the guidelines of the specific clinical setting. Universal masking while in clinical settings, including eyewear when appropriate.
  • Daily self-assessment for symptoms and absolutely not coming to a clinical setting when ill.
  • Attest to absence of symptoms upon entry as per clinical setting policy where applicable.
  • Perform excellent quality and frequently done hand hygiene. Avoid touching your face.
  • Follow site requirements for donning and doffing of PPE, including training, use and re-use parameters, following posted precautions signs to the letter and strict adherence during all direct clinical interactions.
  • Quarantine for 14 days upon arrival in the U.S. from any international travel and notify your faculty of specific details of the travel.
  • [This is already required by schools/programs but clinical partners might want to explicitly state it]: Show documentation of all required vaccines upon start and get vaccinated against influenza in the fall.

Guidelines for clinical faculty/preceptors if learner self-assessment indicates they can not enter a clinical setting

  • Refer learners to the Disability Resource Center as the official mechanism to confidentially share any personal health information or make an accommodation request.
  • Consider virtual / remote clinical placement if the learner is able to participate (e.g., not acutely ill).
  • When in doubt, follow existing university policies / procedures specific to missed clinical / experiential hours.
  • Notify your associate dean of education if any clinical setting is requesting health information from learners (e.g., temperature check, report of symptoms) rather than a person attestation that they are free from symptoms.

Training Resources (table 3)

The table below includes example resources available to help learners meet training requirements. 

Required training might include the following topics, tailored to specific health science programs needs:

  • Theory of infection control and prevention
  • Handwashing 
  • Donning and doffing personal protective equipment 
  • Cleaning / conserving personal protective equipment, when applicable
  • N95 mask fit testing

Additional optional training resources have been compiled, addressing areas including:

  • Remote video interpreter skills
  • Telehealth
  • Emotional health / self-care
  • Respiratory etiquette
  • Communication skills

Note: A faculty workgroup is compiling and vetting resources, and will also be preparing sample modules with objectives and resources that include online/virtual and when necessary, in-person demonstrations. The Office of Academic Clinical Affairs, and MSimulation, will provide coordinated training, and a schedule available to all health science learners will be available early June (first in-person trainings anticipated late June).

Table 3. Training Resources

 

N95 Fit Testing

MSimulation will offer N95 fit testing for health science learners/faculty who will need this service. Estimated start date: June 2020

Who can do N95 fit testing? 

Anyone with proper training and ability to follow the detailed guidelines by OSHA

 

What is entailed in N95 fit testing?

7 standardized activities to challenge mask seal / fit / breathing

Exposure to approved scent/s 

Resources: Qualitative testing  / 3M guide for testing / 3M FAQ

 

How often is N95 fit testing required?

Annually

Anytime there is substantial physical change

Anytime a new N95 mask style is being considered

 

How long does N95 fit testing take?

Roughly 20-30 minutes / person

5 people can be simultaneously tested by one fit tester

 

What happens if someone fails an N95 fit testing?

An alternative to an N95 will need to be considered for these individuals; this typically is a PAPR (costs associated with this). 

 

What supplies are needed for N95 fit testing?

N95 mask

Testing kit/scents (3M kit indicates 150 tests/per solution vial) [rough costs 

 

Documentation of N95 fit testing?

Example template 

 

Who has historically done N95 fit testing at UMN for learners?

Prior to 2019- Medical Reserve Corps (for med school) [conducted the fit testing at no charge]

2019- Outside Vendors (Bulls Eye, MedCompass) (for med school) [rough costs $4 - $20/learner; actual mask is extra cost]

 

Which current UMN entity can do N95 fit testing at UMN for learners?

M Simulation in the Office of Academic Clinical Affairs, with support of the AVP for Clinical Affairs (clinical training), can provide this service to any learners with the need. An N95 fit testing schedule will be set up, beginning as soon as on-campus in-person services will be permitted.

 

What is the OSHA regulation regarding N95 fit testing?

See OSHA 

CDC infographic